胸腔镜辅助食管下段肌层纵行切开术治疗贲门失弛缓症18例  

Video-assisted thoracoscopic lower esophageal sphincter longitudinal myotomy for 18 cases of achalasia

作　　者：何泽锋[1] 王建军[1] 王家顺[1] 潘永成[1] 李劲松[1] 汪文东[1] 赵峰[1] 丁静民[1] 杨光海[1] 马千里[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院胸外科,武汉430022

出　　处：《中国微创外科杂志》2006年第10期735-737,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨胸腔镜辅助食管下段肌层纵行切开术治疗贲门失弛缓症的可行性。方法2000年3月～2004年9月，18例贲门失弛缓症在胸腔镜辅助下行食管下段肌层纵行切开术。游离下段食管及胃贲门部，自下肺静脉至胃贲门部1cm胃壁纵行切开食管下段肌层。结果18例均在胸腔镜下完成手术，无中转开胸，无严重并发症，无死亡。手术时间（108．5±6．5）min，胸腔引流（2．5±0．5）d，术后住院（6．5±0．5）d。术后12、18个月，症状评分由术前（3．1±0．6）分别降为（1．6±0．3）分和（1．9±0．8）分（q=10．558，P〈0．05；q=8．446，P〈0．05）；食管末端直径由术前（7．1±1．3）cm分别降为（3．8±1．2）cm和（3．6±1．3）cm（q=11．046，P〈0．05；q=11．715，P〈0．05）；食管下段括约肌压力（lower esophageal sphincter pressure，LESP）由术前（29．6±3．8）mmHg分别降低到（21．2±2．3）mmHg和（19．2±3．9）mmHg（q=10．443，P〈0．05；q=12．929，P〈0．05）；食管末端pH由术前3．2±0．4分别升至术后5．5±0．3和5．1±0．5（q=23．902，P〈0．05；q=19．745，P〈0．05）；术后12、18个月比较，症状评分、食管末端直径、食管下段括约肌压力均无统计学意义（P〉0．05），但食管末端pH值有统计学差异（q=4．157，P〈0．05）。结论胸腔镜辅助食管下段肌层纵行切开术可行。Objective To explore the feasibility of video-assisted thoracoscopic lower esophageal sphincter longitudinal myotomy for the treatment of achalasia. Methods Eighteen patients with achalasia underwent video-assisted thoracoscopic longitudinal myotomy from March 2000 to September 2004. The distal esophagus and cardia were mobilized. The longitudinal myotomy was performed from the level of the inferior pulmonary vein down to the stomach, extending 1 cm in length on the gastric wall. Results The operation was successfully performed under thoracoscopy in all the 18 patients, without conversions to open surgery. No severe complications or deaths were observed. The operating time was 108.5±6.5 min, the duration for chest drainage was 2.5±0.5 d, and the postoperative hospital stay, 6.5±0.5 d. The scores of symptoms were decreased from 3.1±0.6 preoperatively to 1.6±0.3 and 1.9±0.8 at 12 and 18 months after operation, respectively （q = 10.558, P 〈 0.05; q = 8.446, P 〈 0.05）. The diameter of lower esophagus was decreased from 7.1±1.3 cm preoperatively to 3.8±1.2 cm and 3.6±1.3 cm at 12 and 18 months after operation, respectively （q = 11.046, P 〈 0.05; q = 11.715, P 〈 0.05）. The lower esophageal sphincter pressure （LESP） was decreased from 29.6±3.8 mm Hg preoperatively to 21.2±2.3 mm Hg and 19.2±3.9 mm Hg at 12 and 18 months after operation, respectively （q = 10.443, P 〈 0.05; q = 12.929, P 〈 0.05）. The pH value of distal esophagus was elevated from 3.2±0.4 preoperatively to 5.5±0.3 and 5.1±0.5 at 12 and 18 months after operation, respectively （q = 23.902, P 〈 0.05; q = 19.745, P 〈 0.05）. The symptom scores, the diameter of low esophagus, and the lower esophageal sphincter pressure were not statistically significant between 12 and 18 months after operation （P 〉 0.05）, while the pH value of distal esophagus was statistically significant （q = 4.157, P 〈 0.05）. Conclusions Video-assisted thoracoscopic esophageal longitudinal myotomy is a feasible and effective proce

关 键 词：贲门失弛缓症 电视胸腔镜 食管下段肌层纵行切开术 

分 类 号：R655.4[医药卫生—外科学] R573.7[医药卫生—临床医学]